Probability Of Adverse Outcome Research Articles

Advanced age, comorbidity and the risk of mortality in COVID-19 infection

BackgroundAdvanced age and comorbidities have been described to increase the risk of mortality associated with COVID-19 infection. However, the degree to which comorbidities influence mortality among younger and older adults with and without comorbidity in COVID-19 infection has not been clearly elucidated. ObjectiveTo examine the impact of comorbidity on mortality among younger and older unvaccinated adults with COVID-19 infection admitted to a safety-net hospital. MethodsThis is a retrospective study in which 638 unvaccinated COVID-19 positive study participants admitted to a safety-net hospital between March 1, 2020, and August 31, 2020 were included. The risk of in-hospital mortality or referral to hospice (adverse outcome) was compared among younger and older participants with and without comorbidity. ResultsA total of 62 patients had adverse outcome while in the hospital (10%). Risk factors independently associated with adverse outcome included advanced age (OR(CI) 9.21 (2.29-37.06), p=.002), male sex (OR(CI) 2.6(1.34-5.16), p=.005), living in most disadvantaged area (OR(CI) 2.42(1.8-5.42), p=.03), history of diabetes (OR(CI) 2.35(1.12-4.95), p=.023), and history of heart failure (OR(CI) 4.00(2.09-7.63), p<.001). Further analysis after creating risk groups based on participants age and the presence of diabetes and / or heart failure was performed. The probability of adverse outcome was highest among older male participants with comorbidities (Pr =0.315 (CI: 0.176-0.454)). The probability of adverse outcome among older participants without diabetes and heart failure (Pr =0.081 (CI: .010 -0.152) was less than the probability for younger patients with diabetes and heart failure (Pr: 203 (CI: 0.103 – 0.303) ConclusionsWhile older adults with comorbidities were the most vulnerable for adverse outcome, the risk of adverse outcome among older adults without comorbidities was less than that of younger adults with comorbidities.

Maternal Nutrition Status Associated with Pregnancy-Related Adverse Outcomes.

Although maternal nutrition has an impact on fetal development and gestational outcome, tracking maternal nutrition in outpatient practice is still complex and involves proper technical capacitation in this area. Nevertheless, the association between nutritional variables may broaden the ability to predict the occurrence of gestational disorders and prevention management. We aimed to identify factors that could indicate the probability of adverse outcomes in mid-pregnancy. From a cohort of 1165 nulliparous pregnant women without any previous disease, the nutritional status was assessed by body mass index (BMI) and mid-upper arm circumference (MUAC), associated with dietary patterns and sociodemographic characteristics. Two predictive models with nutritional status for screening the occurrence of adverse outcomes of preterm birth, gestational diabetes mellitus, small-for-gestational-age newborns and preeclampsia were developed. The odds of adverse outcomes were higher in non-white (p < 0.05) obese women and with high protein consumption. There was no significant difference between the models, with an overall accuracy of 63% for both models and a probability of success in predicting adverse outcomes (BMI = 61%, MUAC = 52%). This study of Brazilian pregnant nulliparous women offers two possible options for early tracking of adverse gestational outcomes that should be further externally validated.

Pregnancy Outcomes of Single/Double Blastocysts and Cleavage Embryo Transfers: a Retrospective Cohort Study of 24,422 Frozen-Thawed Cycles

This study aims to evaluate the effect of blastocyst- and cleavage-stage embryo transfers with different numbers of transferred embryos on pregnancy outcomes in China. This was a retrospective cohort study that collected 24,422 frozen-thawed embryo transfer (FET) cycles in two affiliated hospitals of Peking University Health Science Center between January 2015 and May 2018. They were divided into four groups: the single cleavage-stage embryo transfer group (C-1) (763 cycles), double cleavage-stage embryo transfer group (C-2) (13,004 cycles), single blastocyst-stage embryo transfer group (B-1) (7913 cycles), and double blastocyst-stage embryo transfer group (B-2) (2046 cycles). Of the four groups, the live birth rate was the lowest in the C-1 group (11.8%) while it was the highest in the B-2 group (33.6%). However, the B-2 group was accompanied with higher risks of miscarriages, maternal complications, twin births, preterm births, and low birth weight. Compared with the C-2 group, the B-1 group had a lower live birth rate (23.0 vs 29.0%; aOR, 0.78; 95% CI, 0.72–0.85), but also had a lower risk for twin births (1.9 vs 23.4%; aOR, 0.06; 95% CI, 0.04–0.09) and preterm births (9.6 vs 16.1%; aOR, 0.51; 95% CI, 0.41–0.65). The probability of live birth in the B-1 group declined from 0.25 at 20–29 years old to 0.08 at > 40 years old, while the probabilities of adverse outcomes went up with maternal age. It can be concluded that single-blastocyst embryo transfer seems to be the best choice for all maternal ages. This group of embryo transfer has significantly reduced adverse neonatal outcomes. Especially, women with younger maternal age in this group appear to prominently benefit from single-blastocyst transfer.

Comparison of Reperfusion Strategies for ST-Segment-Elevation Myocardial Infarction: A Multivariate Network Meta-analysis.

BackgroundWe systematically reviewed trials comparing different reperfusion strategies for ST‐segment–elevation myocardial infarction and used multivariate network meta‐analysis to compare outcomes across these strategies.Methods and ResultsWe identified 31 contemporary trials in which patients with ST‐segment–elevation myocardial infarction were randomized to ≥2 of the following strategies: fibrinolytic therapy (n=4212), primary percutaneous coronary intervention (PCI) (n=6139), or fibrinolysis followed by routine early PCI (n=5006). We categorized the last approach as “facilitated PCI” when the median time interval between fibrinolysis to PCI was <2 hours (n=2259) and as a “pharmacoinvasive approach” when this interval was ≥2 hours (n=2747). We evaluated outcomes of death, nonfatal reinfarction, stroke, and major bleeding using a multivariate network meta‐analysis and a Bayesian analysis. Among the strategies evaluated, primary PCI was associated with the lowest risk of mortality, nonfatal reinfarction, and stroke. For mortality, primary PCI had an odds ratio of 0.73 (95% CI, 0.61–0.89) when compared with fibrinolytic therapy. Of the remaining strategies, the pharmacoinvasive approach was the next most favorable with an odds ratio for death of 0.79 (95% CI, 0.59–1.08) compared with fibrinolytic therapy. The Bayesian model indicated that when the 2 strategies examining routine early invasive therapy following fibrinolysis were directly compared, the probability of adverse outcomes was lower for the pharmacoinvasive approach relative to facilitated PCI.ConclusionsA pharmacoinvasive approach is safer and more effective than facilitated PCI and fibrinolytic therapy alone. This has significant implications for ST‐segment–elevation myocardial infarction care in settings where timely access to primary PCI, the preferred treatment for ST‐segment–elevation myocardial infarction, is not available.

Adverse health outcomes among workers of wood pellet production facilities.

Workers of pellet production facilities (WPPF) are exposed to high concentrations of wood dust and microbial pollutants. Such stimulation may lead to numerous allergic and toxic reactions, infections, and other non-specific syndromes. To check the influence of individual traits of workers and characteristic features / factors of their living and working environments on the probability of adverse outcomes' appearance. The questionnaire study assessing adverse health effects resulting from individual exposure was conducted among 28 workers of 10 Polish WPPF. The logistic regression (for dichotomous variables) was used to determine the appearance probability (given as odds ratio) of adverse symptoms or diseases. WPPF workers may have an increased risk of developing work-related adverse health outcomes. Both the individual traits and environmental exposure factors significantly influence the probability of their occurrence.

Per l clínico, angiográ co e preditores de mortalidade hospitalar no tratamento percutâneo de lesões em enxertos venosos

ABSTRACT Background The angiographic characteristics associated with saphenous vein graft degeneration and the high-risk profile of these patients increase the probability of adverse outcomes during and after percutaneous coronary intervention. This study set out to analyze the clinical and angiographic profile of patients, procedural characteristics, and hospital outcomes of percutaneous coronary intervention performed in saphenous vein grafts, and to investigate predictors of in-hospital mortality in this group. Methods A retrospective, observational study based on records kept by Central Nacional de [...]

MULTIFACTOR PREDICTION OF LONG-TERM OUTCOMES OF ACUTE CORONARY SYNDROME WITH SUSTAINED ST SEGMENT ELEVATION

Aim. Prediction of long-term (annual) adverse and benefit outcomes of acute coronary syndrome with sustained ST elevation (STEMI) for the improvement of rehabilitation, secondary prevention and personified approach to treatment. Material and methods. Totally 145 patients included with STEMI (106 men, 39 women), hospitalized to the CCH №1 of Novosibirsk during the year 2010. Mean age of the patients was 59,1±6,1 y. Diagnosis of ACS was set by a collection of criteria developed by European Society of Cardiology and American Heart Association (2000). All patients underwent clinical and instrumental investigation as following: clinical examination, electrocardiography, echocardiography, Holter monitoring, measurement of the inflammatory cytokines and molecular-genetic test. By the methods of factor and correlation analysis, the study made it to define the influence of the each of the factors studied on probability of adverse annual prognosis. Results. As the result of the study, we invented a brand new method of multifactor prediction of long-term (annual) adverse and positive outcomes of the acute coronary syndrome with sustained ST elevation. The model includes the check for the absence or existence in the patient of diabetes mellitus (DM), ejection fraction of the left ventricle (EF LV), ultrasensitive C-reactive protein concentration (hsCRP), and genotype for polymorphism rs1376251 of the gene TAS2R50. Sensitivity of the proposed method of prediction for adverse outcomes was 82%, positive outcomes — 80%. Conclusion. The model proposed was created on the basis of the parameters measured in Russian patients and includes the activity of atherosclerotic inflammation and the patient’s genotype. An equation for the probability calculation of an adverse outcome shows, what is the weight multiplier of one or another factor to influence the probability of adverse outcome. The model is simple in use and makes it possible to individualize secondary prevention for this type of patients.

Skilled Versus Unskilled Assistance in Home Delivery: Maternal Complications, Stillbirth and Neonatal Death in Indonesia

The purpose of this study was to compare adverse intra-partum and post-partum outcomes for home deliveries with skilled and unskilled birth assistance. A cross-sectional study examined Indonesia Demographic Health Survey (IDHS 2007) data for 3,811 ever-married women who had had home deliveries in 2006 and 2007. A logistic regression analysis was used to examine associations between type of assistance at delivery and outcomes. This study found that there was a significantly higher probability of adverse outcomes with skilled assistance than with unskilled assistance for complications at birth and for complications after giving birth. Home deliveries with skilled assistance are not free from the risks of maternal morbidity and neonatal death. This finding raises doubts about the impact of skilled birth assistance. These results call for appropriate training to manage complications during and after childbirth by home delivery using skilled birth assistance. Further research is required.

Impact of cystatin C elevation and albuminuria on probability of adverse outcomes in HIV-infected men receiving HAART

Highly active antiretroviral therapy (HAART) has contributed to the longevity of human immunodeficiency virus (HIV)-infected patients; however, improved survival has been accompanied by an increase in the prevalence of kidney disease. Kidney disease may be partly responsible for higher morbidity in HIV-infected patients than in HIV-uninfected subjects. A total of 515 well-controlled HIV-infected men on HAART was enrolled in a 3-year prospective cohort study. The incidence of cancer and CVD was investigated over time. The impact of cystatin C elevation and albuminuria at baseline on the incidence of each disease was examined. Albuminuria was estimated by determining the albumin-to-creatinine ratio (ACR). The cumulative incidence of cancer and CVD was analyzed using the Kaplan-Meier method, stratified by the presence and absence of elevated cystatin C and albuminuria biomarkers. Cox proportional hazards analysis was used to calculate the hazards ratio (HR) and 95% incidence interval (CI) of each biomarker, adjusted for known risk factors. All participants completed the 3-year follow-up study. During the follow-up period, cancers and CVD developed in 13 (2.5%) and 14 (2.7%) participants, respectively. The Kaplan-Meier estimates were significantly increased for cancer incidence in patients with cystatin C elevation and for CVD in those with albuminuria. The HR (95% CI) of cystatin C elevation for occurrence of cancer was 6.09 (1.30 - 24.6) and the HR (95% CI) of ACR ≥ 20 mg/g for CVD was 8.97 (2.20 - 60.8). Cystatin C elevation and/or albuminuria at baseline in HIV-infected men undergoing HAART may be associated with poor prognosis.

Screening pregnant women for autoimmune thyroid disease: a cost-effectiveness analysis.

Untreated maternal hypothyroidism during pregnancy can have adverse consequences on maternal health and child intelligence quotient (IQ). Our objective was to examine the cost-effectiveness of screening pregnant women for autoimmune thyroid disease. We developed a state-transition Markov model and performed a cost-effectiveness analysis of screening pregnant US women, aged 15-45 years, with no known history of thyroid disease, in the first trimester. Three strategies were compared: 1) no screening, 2) one-time screening using anti-thyroid peroxidase (anti-TPO) antibodies, and 3) one-time screening using TSH. Screening tests were added to the laboratory tests of the first prenatal visit. Abnormal screening tests were followed by further testing and subsequent thyroxine treatment of hypothyroid women. Screening pregnant women in the first trimester using TSH was cost-saving compared with no screening. Screening using anti-TPO antibodies was cost-effective compared with TSH screening with an incremental cost-effectiveness ratio of $15,182 per quality-adjusted life year. Screening using TSH remained cost-saving across a wide range of ages at screening, costs of treatment, and probabilities of adverse outcomes. The cost-effectiveness of anti-TPO screening compared with TSH screening was mostly influenced by the probability of diagnosing hypothyroidism in unscreened subjects or subjects with a normal screening test. Screening remained highly cost-effective in scenarios where we assumed no improvement of child IQ outcomes by levothyroxine treatment. Screening all pregnant women for autoimmune thyroid disease in the first trimester is cost-effective compared with not screening.

Einige Überlegungen zur Prävention von Devianz und Wirtschaftskriminalität im Ernährungssektor

Opportunistic malpractice of food business operators entails unacceptable technological procedures and increased probabilities of adverse outcomes for trading partners (including final consumers) and the society. Despite growing societal awareness, little empirical research has been conducted in this field, leaving large knowledge gaps as to the identification and reduction of behavioural food risks. In game theory, such behavioural risk sources – which often constitute punishable offences of the “white collar crime” type – are also known as “moral hazards”. Moral hazards are endemic in economic relations characterised by asymmetric information and opposed interests, such as those between sellers and buyers of food products, but also those between food business operators and public monitoring authorities. The probability of malpractice and white collar crime in the food sector increases with misdirected economic incentives, i. e. the expected profit it is able to produce. It decreases with protective factors, i. e. the bonds to moral norms that prevent producers from giving way to economic temptations. This paper aims to show that, and how, a systematic consideration of behavioural food risks can be made part of routine food risk analysis and monitoring. It considers both the reduction of misdirected economic incentives and the reinforcement of protective factors.

Precautionary decision making: analysis and results

We address how society can manage potentially severe or irreversible outcomes when different combinations of variability, uncertainty and limited causal knowledge characterise them. We outline a decision-analytic solution focused on risky decisions that accounts for prior scientific beliefs and can be updated as subsequent information becomes available. As a practical and established approach to causal reasoning and decision making under risk, this (Bayesian) method helps decision makers, because it formally accounts for probabilistic outcomes and new information. The rational choice of action from the set of alternative actions requires accounting for costs, benefits, and changes in the probabilities of adverse outcomes associated with each action, as well as for the appropriate measures of uncertainty that characterise those outcomes. Decisions under the precautionary principle must account for the contingent nature of scientific information, linking to the principle of expected value of information (VOI), to show the relevance of new information.

Optimal commodity taxation with moral hazard and unobservable outcomes.

The optimal public insurance-taxation scheme is derived for a model with unobservable outcomes. If the government can only observe aggregate commodity expenditures, reimbursement insurance is constrained-efficient. However, two distortions accompany the reimbursement scheme. First, consumers are induced to take (forego) actions which increase (decrease) the likelihood of adverse outcomes (i.e., ex ante moral hazard). Second, reimbursement insurance creates a subsidy distortion (i.e., ex post moral hazard). Ex ante moral hazard calls for taxation (subsidization) of commodities which increase (decrease) the probability of adverse outcomes. The second distortion calls for taxation (subsidization) of commodities which are sufficiently strong complements to (substitutes for) the insured commodity. An example centered on cigarettes and medical insurance is presented.

Mechanisms underlying Children's susceptibility to environmental toxicants.

An important public health challenge has been the need to protect children's health. To accomplish this goal, the scientific community needs scientifically based child-specific risk assessment methods. Critical to their development is the need to understand mechanisms underlying children's sensitivity to environmental toxicants. Risk is defined as the probability of adverse outcome and when applied to environmental risk assessment is usually defined as a function of both toxicity and exposure. To adequately evaluate the potential for enhanced health risks during development, both child-specific factors affecting toxicity and exposure need to be considered. In the first section of this article, example mechanisms of susceptibility relevant for toxicity assessment are identified and discussed. In the second section, examples of exposure factors that help define children's susceptibility are presented. Examples of pesticide research from the newly funded Child Health Center at the University of Washington will be given for illustration. The final section discusses the importance of putting these considerations of children's susceptibility into an overall framework for ascertaining relevancy for human risk assessment.

Patients' preferences for risk disclosure and role in decision making for invasive medical procedures.

To assess the level of involvement patients want in decision making related to the acceptance or rejection of an invasive medical intervention and whether their preference for decision making is related to their preference for qualitative (verbal) or quantitative (numeric) information about the risks of the procedure. A university-based Department of Veterans Affairs Medical Center. Cross-sectional study using structured interviews of consecutive patients seen for continuity care visits in a general medicine clinic. Four hundred and sixty-seven consecutive patients with a mean age of 65.2 years (SD 10.70 years, range 31-88 years) and with a mean of 12.6 years (SD 2.96 years, range 0-24 years) of formal education. In the context of an invasive diagnostic or therapeutic intervention, patients were asked whether they preferred patient-based, physician-based, or shared patient-physician decision making. Patients were asked to give the ratio of patient-to-physician decision making they preferred, and whether they preferred discussions using words, numbers, or both. Of 467 subjects, 318 (68%) preferred shared decision making; 100 (21.4%) preferred physician-based decision making; and 49 (10.5%) preferred patient-based decision making. In terms of risk disclosure, 436 (93.4%) preferred that their physician disclose risk information to them. Of these 436 patients, 42.7% preferred disclosure of information about the probability of adverse outcomes using qualitative (verbal) expressions of probability; 35.7% preferred disclosure in terms of quantitative (numeric) expressions of probability; and 9.8% preferred disclosure in both qualitative and quantitative terms. Younger patients (odds ratio [OR] 0.96; confidence interval [CI] 0.93, 0.99), patients who had at least one stroke (OR 3.03; CI 1.03, 8.90), and patients who preferred to discuss risk information with their physicians in terms of numbers (OR 2.39; CI 1.40, 4.06) tended to prefer patient-based or shared decision making. Male veterans consistently preferred shared patient-physician decision making in the context of invasive medical interventions.

Testing Models Predicting Severity of Respiratory Syncytial Virus Infection on the PICNIC RSV Database

To determine the sensitivity and specificity of published prognostic models to predict morbidity resulting from lower respiratory tract disease caused by respiratory syncytial virus in an independent pediatric population and to assess the accuracy of single risk factors in predicting adverse outcome. All articles obtained from a MEDLINE search that used the terms prognosis or sequelae and respiratory syncytial virus, and from the references of these articles, were reviewed. Studies were included if risk factors and outcomes were defined and if information was available in a database of prospectively enrolled patients with respiratory syncytial virus infections. A probability of adverse outcome was assigned to each patient in the cohort using prognostic models described in the articles. A test was considered positive if the probability of the adverse outcome was 5% or more. Six hundred eighty-nine patients hospitalized with respiratory syncytial virus in seven tertiary care centers across Canada were prospectively enrolled in the Pediatric Investigators Collaborative Network on Infections in Canada database. The sensitivity and specificity of single predictors and of models in predicting severe disease were determined. The sensitivity of single predictors varied from 17% to 46%. A model that used age and oxygen saturation at admission in previously well infants had a sensitivity of 98% and a specificity of 47% when predicting intensive care unit admission. Another model that included age at hospitalization, gestational age, presence of an underlying condition, and respiratory syncytial virus subtype used to predict the outcome of a high severity index had a sensitivity of 77% and a specificity of 76%. When the above model was modified by exclusion of viral subgroup, sensitivity increased to 94%, but specificity decreased to 46%. Previously described prognostic models were generalizable to an independent study population.

Relative Effectiveness of Four Preoperative Tests for Predicting Adverse Cardiac Outcomes After Vascular Surgery

Various noninvasive tests have been proposed to stratify perioperative cardiovascular risk, including dipyridamole thallium scintigraphy (DTS), ejection fraction estimation by radionuclide ventriculography (RNV), ischemia monitoring by ambulatory electrocardiography (AECG), and dobutamine stress echocardiography (DSE). Which of these tests is most effective for predicting adverse perioperative cardiac outcome? To answer this question, and also to stimulate future studies, we evaluated 56 studies examining one or more of the four tests. We conducted meta-analysis on 20 studies that met the inclusion criteria. Outcome measures evaluated were cardiac death or myocardial infarction occurring during hospital stay or within 1 mo after surgery. Relative risk (RR), which is the probability of adverse cardiac outcome when the test is positive divided by the probability of adverse outcome when the test is negative, was used to combine evidence from different studies. An empirical Bayes procedure with a normal-normal hierarchic model was then used to obtain a meta-analytic confidence interval for the overall median of the relative risks. The between-study variance was estimated using the method of moments approach described by DerSimonian and Laird (Controlled Clin Trials 1986;7:177-88). Combined (median) RR [95% confidence interval (CI)] and the number of studies included in our meta-analysis for different evaluative tests were as follows: DTS 4.6 (2.1-10.4) (n = 6); RNV 3.7 (1.6-8.3) (n = 5); AECG 2.7 (1.4-5.1) (n = 6), and DSE 6.2 (1.7-22.8) (n = 3). We conclude that while DTS, RNV, AECG, and DSE are effective (the 95% CIs are greater than 1.0) in predicting the cardiac outcome after vascular surgery, the data are not definitive in determining the optimal test (95% CIs for RR overlap). Future studies should include DSE, as this test shows great promise for predicting adverse cardiac events after vascular surgery.